Loss of Protective Sensation (LOPS) Basics
Diabetic sensory neuropathy, or peripheral neuropathy, is the most common factor leading to amputation in people with diabetes. In diabetes, sensory neuropathy is an anatomically diffuse process primarily affecting autonomic and sensory fibers; however, distal motor findings may be present in advanced cases. Long nerves are affected first, with symptoms typically beginning insidiously in the toes and then advancing proximally. This leads to loss of protective sensation (LOPS), whereby a person is unable to feel minor trauma from chemical, mechanical, or thermal sources. When foot lesions are present, the reduction in autonomic nerve functions may also inhibit wound healing.
Medicare Coverage for LOPS
Medicare covers, as a physician service, an evaluation (examination and treatment) of the feet once every six months for individuals with a documented diagnosis of diabetic sensory neuropathy and loss of protective sensation, as long as the beneficiary has not seen a foot care specialist for some other reason in the interim.
Reporting of this service requires, at minimum, a patient history, a physical examination (including visual inspection of the forefoot, hindfoot, and toe web spaces; evaluation of protective sensation; evaluation of foot structure and biomechanics; evaluation of vascular status and skin integrity; and evaluation and recommendation of footwear) and patient education.
Medicare does not allow for separate payment of an E/M code and a diabetic foot evaluation on the same date. Should you provide a diabetic foot exam to a patient with a documented diagnosis of diabetic sensory neuropathy and loss of protective sensation and not provide significant other E/M services on the same date, it may be beneficial to report this using the codes for the diabetic foot evaluation and treatment.
Applicable CPT Codes
The Medicare Advantage Policy Guideline documents are generally followed by most of the commercial payers. They also follow Medicare guidelines such as LCDs, NCDs, and other Medicare manuals for the purposes of determining coverage. It is expected providers retain or have access to appropriate documentation when requested to support coverage.
Some of the services that Medicare will cover for diabetics diagnosed with sensory neuropathy and LOPS include cutting or removal of corns and calluses; nail trimming, cutting, or debriding; and preventive maintenance foot care. These can be performed in the office, in an outpatient setting, or in the patient’s home.
- CPT G0245: Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS). You can report G0245 the first time a diabetic patient sees your provider. You’ll use this code to report routine foot care for patients who have diabetes and a documented loss of sensation but who have adequate circulation.
- CPT G0246: Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS). You can use G0246 when an established diabetic patient comes in for follow-up care.
- CPT G0247: Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS). You can report G0247 when your provider performs any allowed routine foot care procedure mentioned above. Code G0247 must be billed on the same date of service with either G0245 or G0246 in order to be considered for payment.
Billing and coding tasks can be quite demanding, it may not make much economic and strategic sense to run these operations in-house. In addition, the industry is changing at an unprecedented rate, making it difficult for medical practices to keep up with the ever-changing rules and regulations in medical billing and coding.
Medical Billers and Coders (MBC) provides medical billing and coding services that ensure on-time and accurate billing. We understand the importance of entering the right information so there are no delays or denials on behalf of the insurance provider. To know more about our billing services, you can contact us at 888-357-3226/ firstname.lastname@example.org